| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
248 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
758 |
723 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
532 |
495 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
232 |
$0.00 |
| D4346 |
|
259 |
231 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
138 |
129 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
324 |
207 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
30 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
126 |
107 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
26 |
$0.00 |
| D0601 |
|
15 |
15 |
$0.00 |
| D1110 |
Prophylaxis - adult |
584 |
561 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
397 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
626 |
564 |
$0.00 |
| D0330 |
Panoramic radiographic image |
250 |
219 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
69 |
$0.00 |
| D1120 |
Prophylaxis - child |
64 |
64 |
$0.00 |